Surgical Suturing Instrument

ABSTRACT

A surgical suturing instrument includes a handle assembly, an elongate member extending distally from the handle assembly, and an end effector attached to the distal end of the elongate member. The end effector may include a first jaw member movable relative to a second jaw member between an open position and an approximated position for grasping tissue. Each of the jaw members defines a knife slot, a first needle slot, and a second needle slot extending along a longitudinal axis of the end effector. The end effector also includes a knife assembly and an upper assembly pivotably coupled to an upper knife flange of the knife assembly. The upper assembly includes an upper bellcrank, a first needle, a first suture passing through a first aperture defined by the first needle, a second needle, and a second suture passing through a second aperture defined by the second needle.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. patent applicationSer. No. 14/624,886, filed on Feb. 18, 2015, which claims the benefit ofand priority to U.S. Provisional Patent Application No. 62/042,844,filed Aug. 28, 2014, the entire disclosure of each of which isincorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to instruments, systems, and methods forsuturing or stitching and, more particularly, to end effectors, systems,and methods for surgical suturing and/or stitching through an accessdevice.

2. Discussion of Related Art

In many surgical procedures, including those involved in minimallyinvasive surgery and those in non-minimally invasive procedures,suturing bodily organs or tissue may be part of the procedure. Minimallyinvasive suturing procedures can be challenging due to the smallopenings through which the suturing of bodily organs or tissues must beaccomplished.

During open surgery, suturing of bodily organs or tissue is achievedthrough the use of a sharp needle having a length of suture materialattached at one of its ends. The surgeon stitches tissue by penetratinga suture needle through bodily tissue and pulling the suture materialthrough the bodily tissue. Once the suture material is pulled throughthe bodily tissue, the surgeon forms a knot in the suture material tosecure the suture material to the bodily tissue.

During endoscopic surgery, knotting of the suture material is especiallytime consuming and burdensome due to the difficulty in maneuvering asuture needle through the small endoscopic openings.

Many attempts have been made to provide devices to overcome thedisadvantages of conventional suturing. Such devices include clipappliers, clamping devices and stapling devices. However, such priordevices are limiting in that these devices dispense staples, clips,clamps, or other fasteners which are of a predetermined length, and arenot able to adapt or adjust to different tissue thicknesses.

SUMMARY

In an aspect of the present disclosure, an end effector for use with asurgical instrument is disclosed. The end effector includes a first jawmember movable relative to a second jaw member between an open positionand an approximated position for grasping tissue. Each of the jawmembers defines a knife slot, a first needle slot, and a second needleslot extending along a longitudinal axis of the end effector. The firstneedle slot and the second needle slot may be located on opposite sidesof the knife slot. The end effector also includes a knife assembly andan upper assembly pivotably coupled to an upper knife flange of theknife assembly. The upper assembly includes an upper bellcrank, a firstneedle, a first suture passing through a first aperture defined by thefirst needle, a second needle, and a second suture passing through asecond aperture defined by the second needle.

In an embodiment, the end effector further includes a first upper camsurface and a second upper cam surface extending along a length of thefirst jaw member, and a first cam follower and a second cam followerdisposed on the upper bellcrank. The first and second cam followers areconfigured to slide along the first upper cam surface and the secondupper cam surface, respectively. Any of the cam surfaces may beundulating or wavelike surfaces.

In an embodiment, the end effector further includes a lower assembly.The lower assembly may include a first lower bellcrank, a second lowerbellcrank, a ferrule, and a third suture coupled to the ferrule. Each ofthe first lower bellcrank and a second lower bellcrank is pivotablycoupled to the lower knife flange about respective pivot points. Each ofthe first lower bellcrank and the second lower bellcrank may have aproximal lip, a distal lip, and a cam follower. The ferrule may have aproximal waist configured to engage the proximal lip of the first lowerbellcrank and the proximal lip of the second lower bellcrank, and adistal waist configured to engage the distal lip of the first lowerbellcrank and the distal lip of the second lower bellcrank.

In an embodiment, the end effector further includes a first lower camchannel and a second lower cam channel extending along a length of thesecond jaw member. The cam follower of the first lower bellcrank isconfigured to slide along the first lower cam channel and the camfollower of the second lower bellcrank is configured to slide along thesecond lower cam channel.

In another aspect of the present disclosure, a surgical suturinginstrument is disclosed including a handle assembly, an elongate memberextending distally from the handle assembly and an end effector attachedto the distal end of the elongate member. The end effector includes afirst jaw member movable relative to a second jaw member between an openposition and an approximated position for grasping tissue. Each of thejaw members defines a knife slot and may further define a first needleslot, and a second needle slot extending along a longitudinal axis ofthe end effector. The first needle slot and the second needle slot maybe located on opposite sides of the knife slot. The end effector alsoincludes a knife assembly and an upper bellcrank pivotably coupled to anupper knife flange of the knife assembly. A first needle may bepivotably coupled to the upper bellcrank with a first suture passingthrough a first aperture defined by the first needle. A second needlemay be pivotably coupled to the upper bellcrank with a second suturepassing through a second aperture defined by the second needle.

In an embodiment, the handle assembly may include a fixed handle and amovable handle. Movement of the movable handle toward the fixed handlemay cause approximation of the first jaw member relative to the secondjaw member and movement of the movable handle toward the fixed handlemay cause approximation of the first jaw member relative to the secondjaw member and distal advancement of the knife assembly through the endeffector.

In an embodiment, the end effector further includes a first upper camsurface and a second upper cam surface extending along a length of thefirst jaw member, and a first cam follower and a second cam followerdisposed on the upper bellcrank. The first and second cam followers areconfigured to slide along the first upper cam surface and the secondupper cam surface, respectively. Any of the cam surfaces may beundulating or wavelike surfaces.

In an embodiment, the end effector further includes a lower assembly.The lower assembly may include a first lower bellcrank, a second lowerbellcrank, a ferrule, and a third suture coupled to the ferrule. Each ofthe first lower bellcrank and a second lower bellcrank are pivotablycoupled to the lower knife flange about respective pivot points. Each ofthe first lower bellcrank and the second lower bellcrank may have aproximal lip, a distal lip, and a cam follower. The ferrule may have aproximal waist configured to engage the proximal lip of the first lowerbellcrank and the proximal lip of the second lower bellcrank, and adistal waist configured to engage the distal lip of the first lowerbellcrank and the distal lip of the second lower bellcrank.

In an embodiment, the end effector further includes first lower camchannel and a second lower cam channel extending along a length of thesecond jaw member. The cam follower of the first lower bellcrank isconfigured to slide along the first lower cam channel and the camfollower of the second lower bellcrank is configured to slide along thesecond lower cam channel.

In a further aspect, a surgical suturing instrument includes an upperjaw member and a lower jaw member, an upper reciprocating assemblyassociated with the upper jaw member, and a lower advancing assemblyassociated with the lower jaw member, wherein the upper reciprocatingassembly has a pair of needles and a suture carried by each one of thepair of needles, the lower advancing assembly having a pair of ferrulesand a suture associated with each of the pair of ferrules, the loweradvancing assembly being movable to advance each suture of the loweradvancing assembly.

In the surgical suturing instrument, the upper jaw member can have a camassembly for moving the upper reciprocating assembly throughreciprocating movement. The lower jaw member can have a cam assembly formoving the lower advancing assembly through the lower jaw member.

The upper jaw member and/or the lower jaw member can have a pair oflongitudinal needle slots. The upper jaw member and the lower jaw membercan each have a knife slot.

A knife assembly is arranged to move through the knife slots of theupper jaw member and the lower jaw member, the knife assembly having ablade for cutting tissue.

The knife assembly can have an upper portion for engaging the upper jawmember and a lower portion for engaging the lower jaw member, the knifeassembly maintaining the approximated position of the upper jaw memberand lower jaw member.

The upper reciprocating assembly may pass the pair of needles into thelower jaw member, and the lower advancing assembly may pass the pair offerrules through the lower jaw member. The sutures of the upper jawmember form loops and the sutures of the lower jaw member are passedthrough the loops to effect stitching of any tissue disposed between theupper jaw member and the lower jaw member.

Further, to the extent consistent, any of the aspects and/or embodimentsdescribed herein may be used in conjunction with any or all of the otheraspects and/or embodiments described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and embodiments of the present disclosure are describedhereinbelow with reference to the drawings, wherein:

FIG. 1 is a perspective view of an embodiment of a surgical suturinginstrument in accordance with the present disclosure;

FIG. 2 is an enlarged view of the area of detail in FIG. 1;

FIG. 3 is a bottom perspective view of the end effector of the surgicalsuturing instrument shown in FIG. 2;

FIG. 4 is a front cross-sectional view of the end effector of thesurgical suturing instrument of FIG. 1;

FIG. 5 is a side view of an upper assembly of the surgical suturinginstrument shown in FIG. 1;

FIG. 6A is a top cross-sectional view of a lower jaw member of the endeffector of the surgical suturing instrument of FIG. 1;

FIG. 6B is a side cross-sectional view of an end effector in accordancewith another embodiment of the present disclosure;

FIG. 6C is a side cross-sectional view of the end effector of FIG. 6B;

FIG. 7 is a front view of an upper assembly of the surgical suturinginstrument of FIG. 1;

FIG. 8 is a side view of a lower assembly, with parts separated, of thesurgical suturing instrument shown in FIG. 1;

FIG. 9A is a side cross-sectional view of an end effector suturingtissue portions with a needle assembly in a first position;

FIG. 9B is a side cross-sectional view of the end effector of FIG. 9Awith the needle assembly in a second position;

FIG. 9C is a side cross-sectional view of the end effector of FIG. 9Awith the needle assembly in a third position; and

FIG. 9D is a side cross-sectional view of the end effector of FIG. 9Awith the needle assembly in a fourth position.

DETAILED DESCRIPTION

Embodiments of the present disclosure are now described in detail withreference to the drawings in which like reference numerals designateidentical or corresponding elements in each of the several views. Asused herein, the term “clinician” refers to a doctor, a nurse, or anyother care provider and may include support personnel. Throughout thisdescription, the term “proximal” refers to the portion of the device orcomponent thereof that is closest to the clinician and the term “distal”refers to the portion of the device or component thereof that isfarthest from the clinician.

Details of various embodiments of surgical suturing instruments inaccordance with the present disclosure will now be described in detail.

Referring now in specific detail to the drawings, in which likereference numbers identify similar or identical elements, FIG. 1illustrates a surgical suturing instrument 10. Surgical suturinginstrument 10 includes a handle assembly 20 including a fixed handle 22,and a movable handle 24. The movable handle 24 is movable towards thefixed handle 22 to actuate the instrument 10. A suitable handle assemblyis described in U.S. Pat. No. 5,865,361, which is incorporated herein inits entirety by reference. An elongate tubular body portion 30 extendsdistally from handle assembly 20 and defines a longitudinal axis “L”that extends through proximal and distal end portions of elongatetubular body portion 30. An end effector 100 is supported on the distalend portion of elongate tubular body portion 30 and is remotely operableby handle assembly 20. Alternately, the body portion 30 can be supportedon a robotic arm and actuated by motorized actuator. End effector 100 isadapted to be particularly useful in endoscopic or laparoscopicprocedures wherein an endoscopic portion of the stitching device, i.e.,end effector 100, is insertable into a surgical site, via an accessdevice (e.g., cannula) (not shown) or the like. Alternately, the endeffector 100 is easily adapted for use in a suturing device configuredfor open surgical procedures as will be discussed in further detailbelow.

With reference to FIGS. 2 and 3, end effector 100 includes a first jawmember 110 and a second jaw member 120 movable relative to one anotherbetween an open configuration (FIG. 2) and a closed or clampedconfiguration (FIG. 9A). In embodiments, each of the jaw members 110,120 defines an opposing longitudinal knife slot 96 which extends along acenterline of the respective jaw member 110, 120. The knife slot 96extends from a proximal portion of the jaw members 110, 120 to a distalportion of the jaw members 110, 120.

Each of the jaw members 110, 120 further defines longitudinal needleslots 39 a-d. In particular, with particular reference to FIG. 3, jawmember 110 defines needle slots 39 a and 39 b on a surface configured tocontact tissue. Additionally, with particular reference to FIG. 2, jawmember 120 defines needle slots 39 c and 39 d. The needle slots 39 a-dare disposed in pairs on either side of the centerline of the jawmembers 110, 120. The needle slots 39 c and 39 d of the lower jaw member120 oppose the needle slots 39 a and 39 b of the upper jaw member 110.

Each jaw member 110, 120 may include blunt tip 37 connected to itsdistal end. The blunt tips 37 assist in atraumatically guiding the endeffector 100 between tissue portions and in guiding tissue between thejaw members 110, 120.

Referring briefly to FIGS. 4, 5, and 6A, first jaw member 110 includesupper cam surfaces 612 a, 612 b (FIG. 4) extending along a length of thefirst jaw member 110. Upper cam surface 612 a is disposed on one side ofknife slot 96 and upper cam surface 612 b is disposed on the other sideof knife slot 96. Additionally, second jaw member 120 includes two setsof lower cam channels 614 a, 614 b. In embodiments, one set of lower camchannels 614 a, 614 b is disposed on each side of the knife slot 96.Referring particularly to FIG. 6A, in one embodiment, lower cam channels614 a, 614 b have a horizontal sinusoidal configuration. Alternatively,referring to FIG. 6B, lower cam channels 614 a, 614 b may have avertical sinusoidal configuration. Upper cam surfaces 612 a, 612 b andlower cam channels 614 a, 614 b have a wavelike undulating surface andare configured to impart movement upon upper assembly 400 and lowerassembly 500 as the knife assembly 200 is advanced through end effector100, as will be described in further detail below.

Turning now to FIG. 4, knife assembly 200 includes an upper flange 210,a lower flange 220, and a blade 215 positioned therebetween. Blade 215is supported on or formed with a vertical strut 215 a whichinterconnects the upper and lower flanges 210, 220. Knife assembly 200is configured to be advanced distally through end effector 100 uponactuation of handle assembly 20 (FIG. 1) via a drive rod (not shown)extending through elongate tubular body portion 30 (FIG. 1). A moredetailed discussion of the distal advancement of the knife assembly 200through the end effector 100 upon actuation of the handle assembly 20may be found in U.S. Pat. No. 5,865,361 which has been incorporatedherein by reference in its entirety. As knife assembly 200 is advancedthrough end effector 100, blade 215 travels through knife slot 96 andcuts through tissue that is positioned between jaw members 110, 120.

With reference also to FIG. 7, the upper assembly 400 includes an upperbellcrank 420 and needles 414 a, 414 b pivotally coupled to respectiveends of the upper bellcrank 420 at pivot points 413 a, 413 b,respectively. Upper bellcrank 420 includes downwardly extending camfollowers 412 a, 412 b which are configured to engage upper cam surfaces612 a, 612 b, of first jaw member 110 respectively (FIG. 4). Althoughillustrated and described as being on a bottom surface of the upperbellcrank 420, it is envisioned that cam followers 412 a, 412 b may belocated on any portion of the upper assembly 400. Needles 414 a, 414 binclude apertures 415 a, 415 b, respectively, located on a distalportion thereof. Aperture 415 a is configured to receive suture Sa (FIG.4) and aperture 415 b is configured to receive suture Sb. Distal ends ofneedles 415 a, 415 b are tapered such that needles 415 a, 415 b maypenetrate through tissue. Additional details with regard to operation ofthe upper assembly 400 in connection with knife assembly 200 and endeffector 100 will be described in greater detail below.

Referring also to FIG. 8, lower assembly 500 includes a ferrule 510 andlower bellcranks 520 a, 520 b. In embodiments, two lower assemblies 500are coupled to knife assembly 200 (FIG. 4), each being attached to lowerknife flange 220 on opposing sides of blade 215. For simplicity, only asingle lower assembly 500 will be described. A suture Sc or Sd isattached to a proximal portion 511 of ferrule 510. Ferrule 510 includesproximal waist 512 and distal waist 514. Each proximal and distal waist512, 514 has a smaller diameter then the body of ferrule 510. Lowerbellcranks 520 a, 520 b include proximal lips 522 a, 522 b,respectively, and distal lips 524 a, 524 b, respectively. Proximal waist512 is configured to receive the proximal lips 522 a, 522 b of lowerbellcranks 520 a, 520 b and distal waist 514 is configured to receivedistal lips 524 a, 524 b of lower bellcranks 520 a, 520 b.

In embodiments, distal lips 524 a, 524 b include resilient members 526a, 526 b. Additionally, lower bellcranks 520 a, 520 b include camfollowers 525 a, 525 b disposed adjacent proximal ends thereof. Althoughcam followers 525 a, 525 b are illustrated and described as beingdisposed adjacent proximal end of lower bellcranks 520 a, 520 b, it iscontemplated that cam followers 525 a, 525 b may be disposed on anyportion of the lower bellcranks 520 a, 520 b.

Turning again to FIGS. 4-6, and with continued reference to FIGS. 7 and8, upper bellcrank 420 is pivotably coupled to the upper knife flange210 such that upper bellcrank 420 may pivot about pivot 411. Asdescribed above, upper bellcrank 420 includes cam followers 412 a, 412 band needles 414 a, 414 b positioned on each side of the upper bellcrank420. Needles 414 a, 414 b are pivotally coupled to respective endportions of upper bellcrank 420 about pivot points 413 a and 413 b,respectively. Cam followers 412 a, 412 b are configured to move or slidealong upper cam surfaces 612 a, 612 b, respectively. Upper cam surfaces612 a, 612 b extend along the length of the upper jaw member 110 anddefine an undulating, or wavelike (e.g. sinusoidal), surface. As theknife assembly 200 is advanced distally through the end effector 100,cam follower 412 a moves or slides along cam surface 612 a and camfollower 412 b moves or slides along cam surface 612 b. The undulatingcam surfaces 612 a, 612 b cause the upper bellcrank 420 to rotate aboutpivot 411 in reciprocating fashion, as illustrated by arrow “A” (FIG.4), as the knife assembly 200 is advanced distally through the knifeslot 96 of end effector 100. The reciprocating movement of the upperbellcrank 410 about pivot 411 (caused by the interaction between the camfollowers 412 a, 412 b and the undulating upper cam surfaces 612 a, 612b) causes needle 414 a to move through needle slots 39 a, 39 c, and 39e, and causes needle 414 b to move through needle slots 39 b, 39 d, and39 f.

As discussed above, needles 414 a, 414 b include apertures 415 a, 415 b,respectively, located at distal portions thereof which receive suturesSa and suture Sb respectively. In an embodiment, sutures Sa, Sb may be aone-way or barbed suture, where the suture includes an elongated bodyhaving a plurality of barbs extending therefrom. In such configurations,the barbs are oriented in such a way that the barbs cause the suture Sa,Sb to resist movement in a direction towards the bellcrank 420. Suitablesutures for use with the surgical suturing instrument 10 include, andare not limited to, those sutures described and disclosed in U.S. Pat.No. 8,414,612, the entire content of which is incorporated herein byreference.

Turning now to FIG. 6A, and continuing with reference to FIGS. 4 and 8,lower bellcranks 520 a, 520 b of lower assembly 500 are pivotallycoupled to lower knife flange 220. In particular, one pair of lowerbellcranks 520 a, 520 b of lower assembly 500 is pivotally coupled tolower knife flange 220 on one side of blade 215 and a second pair oflower bellcranks 520 a, 520 b is operably coupled to lower knife flange220 on the other side of blade 215. The ferrule 510 is positionedbetween each pair of lower bellcranks 520 a, 520 b. For simplicity, onlyone lower assembly 500 will be described.

Lower bellcranks 520 a, 520 b are configured to advance ferrule 510distally through lower jaw member 120 in such a manner that ferrule 510may pass through a loop L (FIG. 6A) created by suture Sa, thus creatinga stitch. To this end, lower bellcranks 520 a, 520 b are pivotallycoupled to lower knife flange 220, such that lower bellcrank 520 a maypivot about pivot 513 a and lower bellcrank 520 b may pivot about pivot513 b. Cam followers 525 a, 525 b are configured to move or slide alonglower cam channels 614 a, 614 b, respectively, as knife assembly 200 isadvanced distally through end effector 100. With particular reference toFIG. 6A, lower cam channels 614 a, 614 b extend along the length oflower jaw member 120 and define an undulating, or wavelike, surface. Asthe knife assembly 200 is advanced distally through the end effector100, cam follower 525 a moves or slides along cam channel 614 a and camfollower 525 b moves or slides along cam channel 614 b. The undulatingcam channels 614 a, 614 b cause the lower bellcrank 520 a to rotate inreciprocating fashion about pivot 513 a and lower bellcrank 520 b torotate in reciprocating fashion about pivot 513 b as the knife assembly200 is advanced distally through the knife slot 96 of end effector 100.The reciprocating movement of the lower bellcranks 520 a, 520 b aboutpivots 513 a, 513 b causes the proximal lips 522 a, 522 b to move intoand out of engagement with the proximal waist 512 of the ferrule 510 andthe distal lips 524 a, 524 b to the distal waist 514 of the ferrule 510,to effect distal advancement of the ferrule 510 and the suture Sc or Sd,attached thereto.

FIGS. 6B and 6C illustrate another configuration of lower assembly 500where second jaw member 120 has a pair of vertically arranged camchannels 614 a, 614 b. The configuration of FIG. 6B is similar to theconfiguration of FIG. 6A and therefore only the differences between thetwo will be described. In FIG. 6B, the lower bellcranks 520 a, 520 b arepivotally coupled to opposing sides of blade 215, instead of the lowerknife flange 220 of FIG. 6A, such that cam followers 525 a, 525 b maymove or slide along the undulating surface of lower cam channels 614 a,614 b, respectively, as knife assembly 200 is advanced distally. FIG. 6Cillustrates the ferrule 510 in a position with the lower bellcranks 520a, 520 b engaging the ferrule 510 to translate the ferrule 510 throughthe end effector 100.

Turning now to FIGS. 9A-9D, use of a surgical suturing instrument 10 forstitching tissue portions will now be described. Upon grasping tissueportions T1 and T2 between jaw members 110, 120, knife assembly 200 isadvanced distally through end effector 100. In embodiments, the knifeassembly 200 can be advanced through the end effector 100 to move theend effector 100 to a clamped configuration and to suture tissue asdisclosed in U.S. Pat No. 5,865,361 which is incorporated herein byreference. Alternatively, other actuating mechanisms can be used toadvance the knife assembly 200 in relation to the end effector 100. Asdescribed above, distal advancement of knife assembly 200 through endeffector 100 causes reciprocating movement of upper assembly 400 via camsurfaces 612 a, 612 b, and lower assembly 500 via cam channels 614 a,614 b. In particular, as illustrated in FIGS. 9A and 9B, needle 415 a isadvanced downward, in the direction of arrow D, through needle slot 39a. Once needle 415 a protrudes through needle slot 39 a, needle 415 apierces through tissue portions T1 and T2 and enters the lower jawmember 120 through needle slot 39 c. Further distal advancement of knifeassembly 200 then causes needle 415 a to move upward, in the directionof arrow U (FIG. 9C), through needle slot 39 c, tissue portions T1 andT2, and needle slot 39 a. Upon transitioning from the positions shown inFIGS. 9A and 9B to the positions shown in FIGS. 9C and 9D (uponswitching from the downward movement direction to the upward movementdirection) the suture Sa creates a loop L (FIG. 9C) in the bottom jawmember 120.

After creating loop L, and upon further distal advancement of knifeassembly 200 through end effector 100, ferrule 510 is advanced throughloop L to create a stitch. Briefly referring back to FIG. 6A, as lowerassembly 500 is advanced distally through the lower jaw member 120,lower cam channels 614 a, 614 b cause the lower bellcranks 520 a, 520 bto pivot about pivot point 513 a, 513 b, respectively, such thatproximal lips 522 a, 522 b engage the proximal waist 512 of ferrule 510,leaving the distal end of ferrule 510 open to pass the distal portion offerrule 510 through loop L created by needle 415 a. Once ferrule 510 ispassed through loop L, as lower assembly 500 is advanced even furtherdistally through the lower jaw member 120, lower cam channels 614 a, 614b cause the lower bellcranks 520 a, 520 b to pivot about pivot point 513a, 513 b, respectively, such that proximal lips 522 a, 522 b disengagethe proximal waist 512 of ferrule 510, and distal lips 524 a, 524 bengage distal waist 514, leaving the proximal portion 511 of ferrule 510open to pass loop L through the entire lower assembly 500 and ontosuture Sc, thus creating a stitch.

This process is repeated forming additional stitches until the knifeassembly 200 reaches the distal end portion of the end effector 100 oruntil a desired portion of tissue is stitched and cut.

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Any combination ofthe above embodiments is also envisioned and is within the scope of theappended claims. Therefore, the above description should not beconstrued as limiting, but merely as exemplifications of particularembodiments. Those skilled in the art will envision other modificationswithin the scope and spirit of the claims appended hereto.

What is claimed:
 1. A surgical suturing instrument comprising: a handle assembly; an elongate member extending distally from the handle assembly, the elongate member defining a longitudinal axis; an end effector attached to a distal end of the elongate member, the end effector including: a first jaw member movable relative to a second jaw member between an open position and an approximated position for grasping tissue, each of the first jaw member and the second jaw member defining a knife slot extending along a longitudinal axis of the end effector; a knife assembly configured to advance through the knife slot, the knife assembly including an upper knife flange, a lower knife flange, and a cutting element between the upper knife flange and the lower knife flange; an upper bellcrank pivotably coupled to the upper knife flange; and a first needle pivotably coupled to a first end of the upper bellcrank, the first needle defining a first aperture for supporting a first suture therethrough.
 2. The surgical instrument according to claim 1, wherein the handle assembly includes a fixed handle and a movable handle, wherein movement of the movable handle toward the fixed handle causes approximation of the first jaw member relative to the second jaw member.
 3. The surgical instrument according to claim 1, wherein the handle assembly includes a fixed handle and a movable handle and wherein movement of the movable handle toward the fixed handle causes approximation of the first jaw member relative to the second jaw member and further causes distal advancement of the knife assembly through the end effector.
 4. The surgical instrument according to claim 1, wherein the end effector further comprises a second needle pivotably coupled to a second end of the upper bellcrank, the second needle defining a second aperture for supporting a second suture therethrough.
 5. The surgical instrument according to claim 1, wherein the end effector further includes: first and second upper cam surfaces extending along a length of the first jaw member; and first and second cam followers disposed on the upper bellcrank configured to slide along the first upper cam surface and the second upper cam surface.
 6. The surgical instrument according to claim 1, wherein the end effector further includes: a lower assembly including: a first lower bellcrank and a second lower bellcrank pivotably coupled to the lower knife flange, each of the first lower bellcrank and the second lower bellcrank having a proximal lip, a distal lip, and a cam follower; a ferrule having a proximal waist configured to engage the proximal lip of the first lower bellcrank and the proximal lip of the second lower bellcrank, and a distal waist configured to engage the distal lip of the first lower bellcrank and the distal lip of the second lower bellcrank; and a third suture coupled to a proximal portion of the ferrule.
 7. The surgical instrument according to claim 6, wherein the end effector further includes first and second lower cam channels extending along a length of the second jaw member, wherein the cam follower of the first lower bellcrank is configured to slide along the first lower cam channel and the cam follower of the second lower bellcrank is configured to slide along the second lower cam channel.
 8. The surgical instrument according to claim 6, wherein the first upper cam surface and the second upper cam surface are undulating surfaces.
 9. The surgical instrument according to claim 1, further comprising a first needle slot and a second needle slot located on opposite sides of the knife slot. 